腹腔镜与宫腔镜手术治疗Ⅱ型粘膜下子宫肌瘤对宫颈局部微循环、血清AMH影响

Effects of laparoscopic and hysteroscopic surgery for treating patients with type Ⅱ of submucosal uterine fibroids on their cervical local microcirculation and serum AMH level

目的:探讨腹腔镜与宫腔镜手术治疗Ⅱ型黏膜下子宫肌瘤的疗效及对宫颈局部微循环、血清抗穆勒氏管激素(AMH)的影响。方法:回顾性分析2018年6月-2019年6月本院收治的112例Ⅱ粘膜下子宫肌瘤患者临床资料,根据术式不同分为宫腔镜组与腹腔镜组各56例。比较两组手术相关指标、术后并发症、妊娠及复发等情况,手术前后测定宫颈局部微循环参数及血清AMH、促卵泡激素(FSH)、雌二醇(E;)水平。结果:宫腔镜组手术时间、术中出血量、术后肛门排气时间及住院时间均低于腹腔镜组,腹腔镜组肌瘤一次性切除率(100.0%)高于腹腔镜组(91.1%)(均P<0.05)。两组术后宫颈毛细血管管径、血流灌注及血清AMH、FSH、E;水平变化不显著且两组比较无差异(P>0.05)。宫腔镜组并发症(14.3%)发生率和复发率(10.7%)与腹腔镜组(7.1%、3.6%)比较无差异,两组妊娠率无差异(76.7%、68.1%)(均P>0.05),但宫腔镜组妊娠时间短于腹腔镜组(P<0.05)。结论:腹腔镜与宫腔镜手术治疗子宫肌瘤疗效显著,对宫颈局部微循环及AMH的影响均较小,腹腔镜手术一次性切除率高,但宫腔镜手术有创伤更小、术中出血量少等优势且利于缩短术后妊娠时间。

Objective: To explore the curative effect of laparoscopic and hysteroscopic surgery for treating patients with type Ⅱ of submucosal uterine fibroids, and to study their influence on the cervical local microcirculation and the serum anti-Mullerian hormone(AMH) level of the patients. Methods: The clinical data of 112 patients with type Ⅱ of submucosal uterine fibroids from June 2018 to June 2019 were analyzed retrospectively. These patients were divided into group A(56 patients with laparoscopic surgery) and group B(56 patients with hysteroscopy surgery) according to different surgical procedures. The operation-related indicators, and the situations of postoperative complications, pregnancy, and recurrence of the patients were compared between the two groups. The cervical local microcirculation parameters and the serum levels of AMH, follicle stimulating hormone(FSH), estradiol(E;) of the patients before and after surgery were measured. Results: The operative time, intraoperative blood loss, postoperative anal exhaust time, and hospital stay time of the patients in group B were significantly lower than those of the patients in group A, and the rate of one-time resection of myoma(100.0%) of the patients in group A was significantly higher than that(91.1%) of the patients in group B(all P<0.05). There were no significant changes in the cervical capillary diameter and the blood perfusion volume, and the serum AMH, FSH, and E;levels of the patients between the two groups and between before and after operation(P>0.05). There were no significant differences in the incidences of complications(14.3% vs. 7.1%), the recurrence rate of uterine fibroids(10.7% vs. 3.6%), and the pregnancy rate after operation(76.7% vs. 68.1%) of the patients between the two groups(all P>0.05). The duration of post operation to pregnancy of the patients in group B was significant shorter than that of the patients in group A(P<0.05). Conclusion: Laparoscopic and hysteroscopic surgery for treating the patients with typeⅡ of submucosal uterine fibroids have significant effect with less influence on the local cervical microcirculation and the AMH level of the patients.Laparoscopic surgery has higher rate of resection at once,but hysteroscopic surgery has advantage of less trauma and less blood loss during operation,which is more conducive to shorten the duration of post operation to pregnancy.